Carpal tunnel syndrome caused by thrombosed persistent median artery - A case report -

A rare case of carpal tunnel syndrome caused by a thrombosed persistent median artery is presented here. The diagnosis was delayed due to the overlapping cervical radiculopathy. Acute severe pain and nocturnal paresthesia were chief complaints. Ultrasonography, magnetic resonance imaging, and computed tomography angiography revealed that the median nerve was compressed by the occluded median artery. Instead of surgery, conservative therapy was tried. It worked well for six months. The importance of using modalities for decision making of diagnosis and treatment is emphasized in this report.

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD.

Successful use of caudal anesthesia and light sevoflurane mask ventilation for inguinal hernia repair in an infant with multiple large intrapulmonary cysts / 대한마취과학회지

No abstract available.

Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult

Atrial septal defect [ASD] is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography [TEE] is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine [DEX], which is a highly selective a-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation

Diurnal variation of extremely low frequency electromagnetic field in an empty operating room

Extremely low frequency electromagnetic field [ELF-EMF] is harmful to human body and causes various diseases like cancer. ELF-EMF is mainly produced by surgical or anesthetic equipment in operating room. However, it can be made by surrounding electricity without electric device. We measured it in an empty operating room of our hospital over two days and nights. The intensity of ELF-EMF was measured as two-second interval for two days in an empty operating room. One day was divided to three groups; night, morning, and afternoon. Each group continued for three hours due to capacity of ELF-EMF instrument. All of electrical devices were off including lamp, computer and air conditioner. Groups were compared using one-way ANOVA. P<0.05 was considered significant. Mean value of ELF-EMF during 1st and 2nd night was 1.9459 and 1.9486 respectively. It was lower than data of morning and afternoon [P<0.001]. All values [100%] were above 2 mG [micro-Gauss] in daytime. In night time, most of ELF-EMF [99.9%] was below 2 mG. The intensity of ELF-EMF is higher in an empty daytime operating room than at night time

Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma: A case report / 대한마취과학회지

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.

Lumbar Plexopathy Caused by Metastatic Tumor, Which Was Mistaken for Postoperative Femoral Neuropathy

Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.

Post-radiation Piriformis Syndrome in a Cervical Cancer Patient: A Case Report

The piriformis syndrome is a condition allegedly attributable to compression of the sciatic nerve by the piriformis muscle. Recently, magnetic resonance neurography and electrophysiologic study have helped to diagnose piriformis syndrome. High dose radiotherapy could induce acute and delayed muscle damage. We had experienced piriformis syndrome with fatty atrophy of piriformis muscle after radiotherapy for recurrent cervical cancer.

Anesthetic Management for Clipping a Intracranial Giant Aneurysm with Low-flow Deep Hypothermic Cardiopulmonary Bypass and Propofol Infusion: A case report / 대한마취과학회지

A 35-year-old male patient underwent surgery to clip a giant middle cerebral artery aneurysm with closed-chest cardiopulmonary bypass using femorofemoral bypass. Deep hypothermia (18-20 degrees C), low-flow cardiopulmonary bypass and propofol infusion (6-8 mg/kg/h) were used under general anesthesia. Venous drainage via femoral vein was suffcient and ventricular distension was not observed on transesophageal echocardiography. On Electroencephalogram, burst suppression pattern was presented due to deep hypothermia and propofol infusion. Instead of deep hypothermic circulatory arrest perfusion flow was maintained at low-flow (33 ml/kg/min) during aneurysmal clipping. Postoperatively, the patient was transferred to intensive care unit and discharged without neurological deficit.

Intralesional Injection of Ketamine in Postburn Neuropathic Pain: Two cases report / 대한마취과학회지

The scarring process of burns can be accompanied by pain and/or paresthetic sensation which may persist after completion of scar formation. Once the wound is healed, it is possible that paresthetic and/or painful sensations persist as a result of abnormalities in the newly regenerated nerve endings or because of deficient reinnervation of the scarred tissue, that may give rise to abnormal inputs. Existence of glutamate receptors in peripheral nerves innervating normal and inflamed skin has been well addressed. Therefore we tried ketamine in postburn neuropathic pain expecting the antagonistic effect as a NMDA antagonist. We experienced two postburn pain patients who were successfully managed without any significant sign of side effects by an intralesional injection of ketamine and bupivacaine.